I have been involved in the diagnosis and treatment of sleep apnea for over 20 years. My first foray into the industry was with the Silencer in 1993. At that time I had no dental background and the practice of dental sleep medicine was just beginning.  Since that time, I have been involved with all aspects of the diagnostics and treatment of sleep disorders.  I am spending more and more of my time these days in the dental arena.  I am very impressed with the diligence and commitment of the dentist when it comes to working hard to understand all aspects of sleep medicine.


I believe the most misunderstood relationship in the practice of dental sleep medicine is the relationship between the dental lab and the dentist in building oral appliances for the patient.  What is often lost in the discussion of sleep medicine is that each oral appliance is made by hand, by a technician trained in the fabrication of dental devices, to the specification requested by the dentist.


I first witnessed this relationship while Dr. Wayne Halstrom developed the Silencer and his “lab man” Loris Campagnolo (then with Space Maintainers) developed the techniques that became the Silencer system. Here we are 20 years later and Loris is still working with Dr. Halstrom now in his own lab called Echelon in Burnaby British Columbia. When you ask Dr. Halstrom about the Silencer he often refers to the trials of finding materials and developing easily teachable and transferable techniques, all with the help of a highly skilled technician from which to bounce ideas. The Silencer has grown over the years to be a widely used oral appliance in the treatment of OSA. The durability of the device is well known and it is available from some of the best dental technicians in the country, Johns Dental Lab, Burbank Dental and Gergen’s Orthodontic lab to name a few.


The educational requirement of both the dentist and the technician have really evolved in the last several years. Dental sleep treatment is now recognized as first line OSA therapy and is easily accepted by the medical community. The challenges the dental community face in providing these devices have shifted from appliance and dental procedure issues to issues of practice management, medical insurance and patient qualification. 


Once again, the “Lab Man” is not far away. David Gergen C.D.T. of Gergen’s Orthodontic Lab has taken it upon him self to assemble advance courses in sleep dentistry that will give the dentist the tools to understand the requirements of dental sleep medicine outside of the standard dental issues of occlusion, impression technique and appliance selection.  Gergen focuses his courses on all the next steps after the Dr. has begun the practice of dental sleep medicine. Gergen has often told me that, “ the biggest mistake a dentist can make is to assume that sleep medicine is just like tooth whitening or Invisilign”.  The relationship between the dentist and the lab is taken very seriously at Gergen’s Orthodontic lab  “If the dentist is not successful we will never be successful”.


Reports from the Gergen’s courses have been excellent. Dr. Gerbholtz from Denver CO attended the meeting in Sonoma CA and had this to say “I left Sonoma with a new passion and a good working business model that actually made sense and worked. Where before I was seeing only 2 to 6 patients each month, I am now seeing 20 to 24 patients each month after Sonoma”. I found that the focus on internal marketing for the dental practice really paid off for some practices. Dr. Michael Van Leeuwen of Salt Lake City UT reports “I am now seeing three times the number of patients and they are all getting are sleeping better with the modified sleep Herbst appliance”.  My inspiration for this article came from the following quote from Dr. Harry Sugg of Dallas TX. “The in-depth presentations led to a much greater understanding of how we can help our patients with finding solutions to their sleep issues. So many of our questions were answered regarding insurance billing and coding, some we hadn’t even thought of.

“We were floundering before we went to Sonoma, and we had twelve cases in ten months’ time and where we were having problems due to the learning curve in insurance procedures. In just two short months, we now have over forty cases through. We took five staff members that received technical instruction, but more importantly, much more administrative understanding. Due to the detailed explanations given by Dr. Rod & Donna Willey we have been able to help many more patients. They have been tireless in assisting us to reach others with this information. “



In summary, if you are considering the practice of sleep dentistry or are looking for a dental team to treat your patient, take some time and develop the relationship. Understand that each therapy is customized to the patient and there is a whole team of highly trained individuals working behind the scenes making sure that everyone in the process has an excellent outcome.


Gergen’s Ortho provides the following sleep appliances- Sleep Herbst, the Silencer, EMA, TAP website is www.gergensortho.com The next course is in Las Vegas http://gergensortho.com/las-vegas-sleep-symposium

 Randy Clare is a mentor for the following  dental sleep study clubs www.scottsdalestudyclub.com www.sandiegostudyclub.com


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